If you have a problem you would like advice on, please send your letter to the NMAS “Dear Doctor” page. Dr Bond will answer as many letters as possible on the website. As we usually receive several letters on the same subject, they are often dealt with in one reply. So don’t be disappointed if it is not your name on the letter as it may well answer your questions. We hope so. In the interests of an accurate reply, please include as many details as possible such as age, how long on/off HRT and other medical conditions.

January 2008

Dear Dr. Bond,
I wonder if you have any information about the problem of thinning hair after the menopause. My last period was nearly 4 years ago and about a year ago my hair started thinning, especially at the front. I am having a blood test on Monday but my doctor thought it was probably just lack of oestrogen. Are there any supplements which may help? Best wishes Frances Cross

Dr Bond's reply:
Dear Frances, This is not an uncommon problem for women during or after the menopause. There are two main causes, one is a lack of iron. Iron is very important for hair growth and can cause problems long before you actually become sufficiently low in iron to be classified as having anaemia. A good supplement is Spa tone. This liquid rarely causes the constipation so often seen with traditional iron supplements. Another cause of hair loss is not lack of oestrogen, as is commonly thought, but a lack of progesterone. If you think how lovely most women's hair is when they are pregnant, when their progesterone levels are especially high. Whatever you lack, do remember that it takes at least six months before you will see an improvement in your hair loss. This is because many of the follicles will still have dead hair in them and it will take time for it to fall out and new hair to grow.

Dear Dr. Bond,
I had an early menopause at 44 and managed it totally with natural oestrogens and increased exercise. I am now 50 and experiencing very low libido, tiredness and soreness during and after sex. I had investigations with a specialist who recommended medication that did not suit me as it made me have break-through bleeding. I have been on oestrogen pessaries, but have stopped taking them as my GP did not feel it was safe to be on them for any length of time. They did worked, but already, 4 weeks after stopping them, I am experiencing the same discomfort and feel anxious that I am condemning myself to a life without sex. I do not want to take HRT – my family has a history of not coping on HRT and I have had treatment for pre-cancerous cells in the uterus, gall stones and breast pain. Can you recommend any action I might take? Caroline

Dr Bond's reply:
Dear Caroline, This can be a very distressing problem. I would suggest that you try a product called Phyto-Soya Vaginal Gel which is used three or four times a week. You should also take some isoflavones in a supplement such as Estroven. If this doesn’t work you could use the oestrogen pessaries again. These are not a good idea on their own but if you use them in conjunction with some natural progesterone cream they are alright.

August 2007

Dear Dr. Bond,
I have today read with interest your NMAS details and letters on the web pages. I am 55 years old and was on HRT for approximately 10 years, although I have now been off this for 18 months or so. I am having extreme difficulties with vaginal dryness and have been prescribed Ortho-Gynest by the Doctor. At the same time a swab was taken and this showed Bacterial Vaginitis. 5 days of antibiotics seem to have worked. However, the ortho-gynest seems to cause an allergic reaction making everything so much worse. I have read on your web site about Phyto-soya vaginal gel and Black Cohosh for vaginal dryness. I would be obliged if you could let me know where I may purchase both these products and if you could let me have some information regarding these products. Yours faithfully, Mrs Joy Hill

Dr Bond's reply:
The cause of your bacterial vaginitis will be due to the fact that your oestrogen levels are low and so the mucous normally made in your vagina is not as lubricating and protective as it used to be. I am sure that the antibiotics will have cleared the bacteria. However, they will not have improved the mucous and to make matters worse the antibiotics will have destroyed many of the naturally protective bacteria in your vagina. To restore the natural bacteria you need to use some live yogurt. This can be used vaginally as well as taken by mouth. If you do not want to insert supermarket live yogurt, which is very good, you can obtain pessaries from good health shops. To restore the mucous you could use Phyto soya vaginal gel which is made by Arkopharma and obtainable from health shops or you could take some Black Cohosh and Estroven. You should be able to obtain these at Boots. While oestrogen gel would help your vagina it should not be used on its own but combined with natural progesterone to prevent unwanted side effects.

June 2007

Dear Dr. Bond,
I wonder if you would be able to help me in ascertaining my current hormone levels and the best way forward for myself at a time which I am finding rather distressing. I am going through the menopause and have tried very hard to approach this as naturally as possible. But at times this has been unbearable, especially as I have a very demanding job. I find that I can't concentrate due to a complete lack of sleep as a result of waking every 90 minutes with leg cramps and raised temperature. In desperation I have discussed the symptoms with the Doctor who last Wednesday put me on HRT - Livial. I expected to feel loads better but the truth is I suspect that this might have increased the severity of my symptoms. Certainly the night sweats are now more frequent and the hot flushes are approximately every hour now whereas before they had virtually gone. I am now wondering if I am suffering from oestrogen dominance and that the HRT has made this even worse, is this possible?
Please help. Desperately, June

Dr Bond's reply:
The problems associated with the menopause are various and can vary from person to person. It can certainly be useful to establish your oestrogen/progesterone ratio and the best way to do this is with Saliva Hormone Testing. The reason for this is not that they are more accurate than blood tests, but that they calculate the ratio for you and you can do the test yourself from home. Some of your symptoms seem to relate to an imbalance in your hormones and this can often be corrected using vitamin and mineral supplements, plus or minus herbs. I always feel that HRT is a last resort. In addition you refer to muscle cramps, these can be due to salt losses as a results of sweating a lot or a deficiency of Magnesium. I recommend that you take the supplements Estroven and Magnesium OK.

March 2007

Dear Dr. Bond,
I am 42 and had a D & C, cervical diathermy, hysteroscopy in 2002 which cured my heavy bleeding straight away, which I was very pleased with. I have now been getting heavy periods again for about the past 9 months and my Doctor has suggested fitting a coil. I have been asked to book in for an internal in the mean time before they decide what is best for me. I personally really don't fancy the idea of a coil inside me. I have heard various stories about the coil and a friend of mine has had continuous problems with one. My main concern is that I'm 42, I don't have children, but I DO want a child, though I have not met Mr Right as yet and I feel that time is ticking on! Can you tell me what the best option would be in my circumstances please with regard to taking the pill or a coil? I don't really want to go on the pill. At my age, if I met someone and decided I wanted a child, would being on the pill and then coming off it mean it could take longer to conceive than if I were not to go on it? I also recently had a blood test to check for anaemia, as I have been feeling very drained recently. The test showed I was not anaemic. The nurse suggested having a test at some point in the future to see if I was pre-menopausal. I currently have post viral fatigue and with the heavy periods on top, my energy levels are low. I have been feeling sweaty at night (due to the virus), but prior to this I noticed that I had started to experience a bit of flushing at night recently anyway. Is there anything that I can start taking at my age, especially that might help with the fatigue from my heavy periods? Your guidance would be much appreciated. Laura

Dr Bond's reply:
Heavy periods are due to the build up of an excessively thick lining to the uterus each month. This is due to the effects of an excess of the hormone oestrogen that is not being balanced by progesterone. This often happens as women reach their mid 30's, as they no longer ovulate every month. This build up can be prevented by both natural progesterone and its chemical form progestogen. The Mirena coil which has been suggested contains progestogen and stops the lining of the uterus from building up. The periods then become scanty or absent, and this effect is usually reversed when the coil is removed and the lining is once again allowed to build up. While the coil is in it also acts as a method of contraception. I would not recommend the contraceptive pill at your age as it can upset the balance of your hormones and make the possibility of pregnancy less likely when you come off it. You could of course try natural progesterone cream or tablets (please see our fact sheet on this). I would suggest that you take supplements such as Estroven and Mexican Wild Yam to balance your hormones and an iron supplement such as Spa Tone to prevent anaemia from your heavy periods.

Dear Dr. Bond,
My name is Mee. I am a 55 year old married Singaporean with two married daughters and a 16 year old son. I am seeking your help and advice on my hormone problems. My menopause stared over three years ago. I have been using progesterone cream, (PRO-GEST) body cream, emerita, on and off for a number of years now. During that time, I still experienced symptoms of headaches, hair loss, tender breasts mood swings, palpitations, lack of libido, vaginal dryness and poor digestive problems. I rang the lady from NHM about my worries, but she said she cannot think of anything else to help and it is just all trial and error. Over two months ago I was advised to use a stronger dose by a lady from the company where I buy the cream. She prescribed Kokora Balance Cream, PRO- VIVE high potency 3% Natural Progesterone Cream to use with Phytoestrogen and Progesterone E oil. But after using them for over two months, I found no relief from all my symptoms. Instead of improving, all my symptoms seemed to have worsened. Everyday I am losing hair and all the nasty symptoms are still present with depression as well. I have lost weight. All my life I have been under weight, I am 5ft one inch, and now weigh only 37kgs. My appetite is gone, my skin around my fingers are peeling back all the time, I have fungal infections on all my finger nails (been on Candida diet for ages) and my immune system has been weakened. I believe I am on an excellent diet. I have no dairy, no wheat, and no sugar (not by choice) and eat 99% organic food. I don't drink or smoke, drink coffee or black tea and seldom have tofu products. I have a quiet life and I also have a regular intake of supplements, magnesium, fish oils, iron tablets and others, as well as herbs and acupuncture treatments. I don't take any chemical drugs. About a year ago I had tests for thyroid, and test for hormonal levels and the results were fine. I feel very distressed and cannot understand why the progesterone cream (even at a higher does and eating healthy diets) cannot help to ease or to eradicate my unbearable symptoms. Everyday I feel hopelessness, weepiness, discouraged and confused. I am at a loss; desperate, distressed and feel all my problems are insurmountable. Please, Dr Bond, if you can give me some advice and help, I would be most grateful. Thank you kindly. Mee Soh

Dr Bond's reply:
It sounds as if you are having a very difficult time with your menopause. First of all I would say that while progesterone can be very useful at the time of the menopause it is not a cure all and in any case its use should be directed by a doctor who has experience in this field rather than a sales person. There are many things you could do to help your problems but it seems to me as if you really need to have a proper consultation so that the appropriate supplements and if necessary hormones can be prescribed in the correct amounts and to be used in the correct way.

Dear Dr. Bond,
Hi, Can you tell me if you have a product for Natural HRT? If so which one? Thanks Allyson Reid-Montgomery

Dr Bond's reply:
The response to this question depends upon what you mean by “natural HRT”. Do you mean natural substances such as herbs and supplements or do you mean bio-identical hormones? The herbal substances used for treating symptoms, which are often treated with traditional HRT, are those that act in similar ways to hormones but are not hormones themselves. Examples of these are the phytoestrogens which act like very weak oestrogen and can often help to alleviate sweats and flushes. Bio-identical hormones are hormones, but unlike traditional HRT they are identical to the hormones your body makes and are not chemicals. Traditional HRT usually contains just one of our oestrogens, oestradiol, the strong oestrogen combined with a progestogen. Progestogen is a chemical that protects the lining of the uterus from building up excessively and becoming cancerous. Unfortunately it has now been noticed that progestogen can increase the carcinogenic effect of oestrogen on breast tissue. Bio-identical HRT is a combination of the three oestrogens the body normally makes combined with progesterone which is the hormone the body makes to counter any unwanted effects of oestrogen. This has to be prescribed by a doctor.

November 2006

Dear Dr. Bond,
Failing energy levels and seemingly rising levels of stress make maintaining a good work life balance difficult making me fearful of giving up the 'crutch' of HRT. Friends say they lost energy, hair and skin tone when they stopped taking it and your advice would be appreciated. Gemma Jones

Dr Bond's reply:
Dear Gemma I can understand your reluctance to stop taking HRT. You do not say how old you are, how long you have been on HRT or what particular HRT you are taking but I would guess you are in your late 50s. There is no longer any doubt that taking traditional HRT long term increases your risk of breast cancer, however this risk is small. Continuing with HRT or not is a decision that you need to make with your GP bearing in mind your personal medical details. It is important to remember though that HRT is not an elixir of youth, there are many women who have loads of energy without taking HRT. If you come off you HRT it is very important to wean off it slowly, there is more information on how to do this in the fact sheets on the NMAS website (www.nmas.org.uk) together with advice on the supplements to take as you do so.

Dear Dr. Bond,
My mother had a terrible time when she had her menopause and I am anxious not to have the same thing happen to me. I am in my late 40's and my periods have started to become irregular. Someone has suggested that I start HRT.

Dr Bond's reply:
The first thing to remember is that the menopause is not a disease and the fact that your mother had problems does not mean that you will. You should certainly not start on HRT to prevent problems you might not have and as result create problems that you might not have had without the HRT. The most important thing to do at this stage is to look at your diet and life style and ensure that these are as good as possible to help your hormones to remain balanced, You should take a supplement containing isoflavones such as Estroven and combine this with Magnesium-OK to ensure you do have the nutrients you need to maintain a healthy hormone balance.

Dear Dr. Bond,
When I was younger I suffered from PMT and I took a magnesium supplement for this with great benefit. I am now going through my menopause and feel as if I have PMT most of this time. Would this same supplement help me now?

Dr Bond's reply:
The hormone imbalance that produced the symptoms of PMT is the same imbalance that occurs at the time of the menopause. Basically your oestrogens are not being balanced by progesterone. While taking progesterone can help this condition I would certainly suggest that you might well be helped again by topping up your magnesium levels. There are many to choose from but Magnesium-OK for example contains 145mg of magnesium with folic acid and vitamins B, C, D and E.

October 2006

Dear Dr. Bond,
I am in my early forties and finding that I'm experiencing much more noticeable PMS symptoms than previously - headaches, tender breasts and severe mood swings which can just make me want to sit and cry at times. Is this normal? Could I be approaching the menopause? I do not take any medication and have a Mirena coil fitted. I would be grateful for any advice you could give.

Dr Bond's reply:
I would not describe your symptoms as normal but they are certainly not uncommon. As women reach their 40's and often as early as the mid 30s ovulation becomes more erratic even though the periods themselves may remain regular. What is happening is that ovulation no longer occurs every month and even when it does the ovaries do not do their job as efficiently as they should. By this I mean, that normally, following ovulation, the ovary should produce a large amount of a hormone called progesterone. The role of this hormone is mainly to prepare the body for a gestation (pregnancy) but it also plays an important role in balancing the hormone oestrogen. Oestrogen is a very important and useful hormone but if it is not balanced with the correct amount of progesterone a situation of oestrogen dominance occurs. The symptoms of include tender breasts, mood swings, depression, weight gain and fluid retention to list just a few. It sounds as if this is the picture that you fit into at the moment. You are probably some years yet away from your menopause but your hormone balance is beginning to change. The best way to deal with this problem is to pay attention to your diet and life style and make both as healthy as possible. Stress can also have an adverse effect at this time so learning to avoid or deal with it is helpful. In addition you should consider taking supplements formulated especially for women. Confiance and Magnesium OK contain nutrients your body needs to help make and balance your hormones, also to enable your body to cope with stress.

Dear Dr. Bond,
I suffer from very heavy periods which last for at least a week each month. My GP says that this is normal for my age (mid forties) as I am now 'pre menopausal'. I was horrified to think my menopause could be so close already - is this right? If so, I would like to avoid HRT if I could and take a natural approach to this time of change. Is there anything I should be doing now to help me prepare and make this a smooth transition?

Dr Bond's reply:
I would certainly not consider this to be normal although this is not an uncommon situation at this time of life. The menopause can be at any age from the mid 40s through to the mid 50s so you may, or may not, be approaching your menopause. You should ask your doctor for a check up to ensure that the heavy bleeding is not due to some condition that can be treated such as fibroids or polyps. Once you have excluded any medical condition for the bleeding then you need to try and deal with it as naturally as possible. First ensure that you are getting enough iron, otherwise you will soon become tired and lethargic. While red meats and green vegetables are good sources of iron it is difficult to get enough from your diet when you are bleeding heavily. I suggest that you take either Floradix with iron or Spa tone. These are both liquids that do not cause constipation as iron pills often do. You should then try to balance your hormones. Heavy bleeding is usually due to the fact that your oestrogen is building up a thick lining to the uterus and that this is not being controlled by another hormone called progesterone. You can help reduce your oestrogen levels by making sure you eat mainly organic food and drink organic milk. Also, if you are overweight by reducing your fatty tissue. Oestrogen is made in fat cells as well as in the ovaries. If all this fails your should discuss with your GP the possibility of having a Mirena coil inserted since this contains a chemical progesterone which stops the lining of the uterus building up and reduces bleeding. While I normally do not like to suggest chemical hormones this is one problem that responds well to the progestogen insert and it is unusual for any of this progestogen to enter the general circulation.

Dear Dr. Bond,
I take a magnesium supplement at the moment which has helped with PMT symptoms but I am finding that these seem to be creeping back in the past few months. I also tend to get a headache at the start of my period each month now and am wondering if I should be taking something different as I get older (I am 42). Help, I feel as if I am losing my grip on my moods each month just as I did when younger.

Dr Bond's reply:
You are doing the right thing in taking extra magnesium. You do not say which particular supplement you are taking, and I always recommend the Magnesium-OK formulation because it contains additional vitamins and minerals that help the body use the magnesium better as well as working in their own right to help balance you hormones. I would suggest that you also consider taking a supplement containing isoflavones combined with other nutrients. A particularly good one is Estroven and there are others such as Menopace and Aria.

August 2006

Dear Dr. Bond,
I am 70 years of age and still get overheating. It seems to happen mainly a short time after eating, almost anything. I am otherwise in good health. I have read this overheating can go on for a very long time, although it seems to be generally thought that it will end when the menopause is over. It is very unpleasant and feels as if I am being suffocated inside. I can only take off a layer of clothing to cool down. I do not want to take HRT as some of this contains the urine of pregnant horses; involving cruelty and unwanted foals being born also I don't entirely trust HRT from not contributing to other conditions. Is there anything else that might be effective in stopping this condition? My menopause finished when I was 56/57 years of age.

Dr Bond's reply:
It is not unknown for women in their 70's to continue to have sweats and flushings. These are often related to stressful situations. However your problem sounds as if it might be related to what you are eating rather than your hormone balance. Certain foods especially if spicy or highly flavoured as well as coffee and alcohol can induce a sweat. It could also be that you have a food sensitivity. I suggest that you consult a nutritionist. In the mean time you could take some isoflavones combined with vitamins and minerals such as Estroven or Menopace as these might help. Incidentally not all traditional HRT contains urine from pregnant mares. The products containing this are Premarine and Prempack. Other traditional HRTs contain oestradiol, an oestrogen made from plants, combined with a chemical progestogen. I consider it better to take bio-identical hormones if indeed they are needed. Bio-identical hormones contain hormones made from wild yam or soya and contain the three oestrogens in an identical form to those made by your body combined with progesterone, a hormone identical to one made by your body.

July 2006

Dear Dr. Bond,
I am 48, have suffered with moderate M.E for 10 yrs. I cannot work and am finding that the M.E is much worse around my period. I have periods of intense fatigue, weepiness and muzzy head. I think I am probably pre menopausal. I wouldn't say I suffer loss of libido, but definitely loss of sensation, particularly in the clitoral area. Information is very confusing as I also suffer poor digestion and think I have a sluggish liver which I have read can be due to oestrogen dominance. Do you think there is a link between my symptoms or am I suffering different things? I eat a good diet which is wheat free diet, consisting of a good amount of seeds, nuts, soya products, organic fruit and veg. Is there anything else I can do? Thank you.

Dr Bond's reply:
Many of your symptoms are probably related to your ME. However in my experience ME symptoms are often made worse when there are hormone imbalances. You are 48, you do not say whether your periods are still regular or not but in any case your hormones will be beginning to change. The most common change that occurs at this time is related much more to the fall in progesterone levels due to failure of ovulation (to ovulate) than to falls in oestrogen. Oestrogen thus becomes dominant and causes problems in its own right as well as aggravating ME. You need to consider (might be better to say ‘Now would be a good time to consider’) supplements that will enable your body to make and balance your hormones better. I would suggest that you take a supplement containing magnesium, the B vitamins and folic acid. A particularly good product is Magnesium OK. In addition you need a supplement containing isoflavones. It could also help you if you took some digestive enzymes. I would also suggest that you make sure that you are not eating too many soya products as these are not well digested by many people and can make the thyroid sluggish.

Dear Dr. Bond,
I have recently been prescribed the above cream by the hospital. I have a skin condition and have been using dermovate for a little while. Unfortunately this has slightly thinned the skin so have been advised to stop using it. On reading the instructions I find that this cream is in fact HRT which I am a little concerned about. I have gone through the menopause without having to use HRT, I have suffered the normal effects, hot flushes, mood swings, etc but it was my choice to not use anything other than natural remedies. I am therefore a little worried about using this cream due to the side effects listed on the instructions and the fact I had got this far without the need for HRT. Please advise if I should still use the cream and what are the risk levels in real terms.

Dr Bond's reply:
Orthogynest which you have been prescribed is a cream containing oestriol which is one of our oestrogens. It is probably the best oestrogen for dealing with vaginal dryness, however it should not be used on its own for any length of time because of potential side effects. An excellent alternative is Phyto-soya Vaginal Gel. It has also been shown that taking Black Cohosh can help vaginal dryness.

Dear Dr. Bond,
I am a 53 old woman and I suppose I am in the middle of the menopause. I haven’t had a period for about 10 months but for the last 18 months I have had almost daily headaches. I only have a few days when I am totally free of a headache but for most days at some point in the day I have one. The headaches are always on the left side and often behind my left eye. I have been to see a consultant neurologist twice now in Oxford. He has told me that the problem is linked to changing hormonal levels and that there is nothing more sinister wrong with me. I have tried a natural remedy called Menoherbs two produced by Victoria Health and also have taken soya supplements but to no avail. I am getting pretty desperate as chronic pain is extremely tiring and can make me feel depressed. I don’t think I am depressed but I am very fed up with the pain. Could you please advise me. With thanks

Dr Bond's reply:
It is possible that your headaches are due to the hormonal changes taking place at this time. You could consider trying supplements such as the isoflavones which can help balance your hormones although stronger measures may be needed. I would suggest that you have your hormone balance tested, preferably by saliva testing, to see whether or not you are oestrogen dominant (more explanation about both saliva testing and oestrogen dominance is in the factsheets (can be found in the factsheet entitled ‘Testing for Hormones’). If you are oestrogen dominant then using some natural progesterone cream could help. Another line of possible help could be to consult a cranial osteopath.

Dear Dr. Bond,
I wondered if you can help me, I am slowly coming off H.R.T, as I have tried 4 different ones and none suit me, I take Thyroxine daily 100mcg, and have done for years, due to having 2/3 of my thyroid gland removed at 16. I have heard Estroven and Red clover is a good alternative but can I take them with Thyroxine as I have quite severe hot flushes. Hope you can help.

Dr Bond's reply:
How sensible you are to come off your HRT slowly. You are absolutely correct in saying that Estroven containing isoflavones and Red Clover are good alternatives to oestrogen. You can, and I would in fact advise you to take these. They are perfectly compatible with thyroxine.

May 2006

Dear Dr. Bond,
Due to reduced oestrogen resulting in vaginal dryness which topical HRT was no longer resolving, the hospital consultant prescribed low dose Premique but this is apparently not currently available due to a supply problem so the prescription has been changed to the normal dose. However I am rather hesitant about taking HRT anyway as I am unsure of the side effects but am even more concerned now that the low dose has been changed to standard dose. Please can you explain the possible side effects and any other relevant information; it would be appreciated. Thank you Judy Rowson

Dr Bond's reply:
Premique even in a low dose is considered to be one of the least desirable mixes of HRT as it combines an oestrogen from pregnant mares with a chemical progestogen. You do not say what topical oestrogen you are using nor how old you are but it is unusual not to be able to resolve the problem of dryness with local application. I personal believe that this should always be used unless there are severe general symptoms of oestrogen lack as well. I suggest that you use Oestriol cream and/or pessaries. These should be used initially daily for about two weeks, then alternate days, then two to three times a week. Because you should not use oestrogens on their own, even locally, you should also use progesterone cream to balance.

Dear Dr. Bond,
I have read with interest the articles and factsheets on the NMAS website. I will be 40 in November of this year. I am 5’4”, weigh 12 stone, and am in good general health. I take regular exercise at a gym three to four times a week, eat sensibly (generally!) and drink alcohol in moderation (far less than the recommended units per week for women). I am on Microgynon 30 and have been taking it continuously since 1999, apart from 2 months off in June 2004 when I had varicose vein surgery. In the last 6 months or so I have begun to suffer from terrible night sweats, so bad that they often wake me up. I find the bedsheets are soaking wet, and I am soaking wet too! I perspire from places I never knew it was possible to sweat from (e.g. under the eyes). I also suffer from hot flushes during the day, usually in the morning. I also have a degree of blood-sugar instability, resulting in tiredness in the afternoon, but I have been able to conquer this, in part, by modifying my diet. I have successfully followed the low GI diet (not religiously) and lost over a stone last year as a result. In addition, in the last three years I have noticed a marked increase in PMS, usually emotional symptoms such as extreme irritability and “short fuse”. I also get occasional cyclical cluster headaches which are not relieved when I take paracetomol or ibuprofen or both, and breast tenderness, so bad that I find it impossible to take vigorous exercise, despite wearing a very supportive sports bra. These symptoms do not occur every month, and supplementing with Magnesium-OK has helped, but not entirely removed them. I take supplements of Magnesium-OK, Flaxseed and Omega 3 fish oils. My doctor has suggested that I am “very young” to be having pre-menopausal symptoms, but my mother started having similar symptoms when she was 42. I do feel that changes are taking place in my body and I would be grateful for any advice on how to cope with them by natural means. I am reluctant to come off the contraceptive pill for the time being. Thank you in advance for your help. FRANCES WILSON

Dr Bond's reply:
The first thing that you should do is to stop the Microgynon and after a month or two you should ask your GP to check your hormone levels to see whether or not you are approaching the menopause. Then a decision can be taken regarding how to treat your symptoms. In the meantime you should continue to take Magnesium OK and Estroven.You should also consider having a screening test for osteoporosis as you have been on the pill so long.See our fact sheet.

Dear Dr. Bond,
I am 52 and have been taking Estroven for approx. 12 months. I started Estroven after reading about it on your Dear Doctor site. At first Estroven seemed to help but recently it doesn't seem to be helping at all. I have sweats night and day which I would consider to be fairly severe. I have sweat rashes now in various parts of my body including my scalp. It is becoming so embarrassing I don't want to leave the house any more. People who don't know me e.g. my dentist thought I had taken very ill in her surgery as the sweat was running down my face. Over the last year I have made various changes to my diet i.e. no processed food, at least 8 portions of fruit and veg. daily, no alcohol and I have stopped smoking. Nothing seems to help. The sweats are becoming worse all the time. Is there anything else I can do? Please help.

Dr Bond's reply:
You could try adding Red Clover to the Estroven but it sound to me as if you need to be considering the use of hormones. If this is the case I would recommend that you find someone who will prescribe the bio-identical or natural hormones rather than traditional HRT.

Februrary 2006

Dear Dr. Bond,
I am concerned about coming off HRT. I am on estra combi 50 patches and have been for about 9 years. I have no problem with them but my GP says it is time to stop using them. I have asked about weaning off them but she said just leave the patch on longer- however this does not work because the patches do not wear well if I leave them on longer, curling up and coming off or they wear out because of daily bathing. It is just not workable. I had very bad menopause symptoms and have tried to come off them before but my symptoms returned straight away - hot flushes. Anxiety, urge incontinence, etc. My GP says there are no lower dose estra combi patches. Can you suggest any way I can wean myself off them? I have tried Prempac C but they did not agree with me. I still have my womb and I do not suffer with high blood pressure. I hope you can help me as I feel desperate - it was easy to go on HRT but there is not much help to get off it. I will take any herbal supplements you can recommend but there are so many I do not know what can be taken with what. I do take vitamin E at the moment. I will be very grateful for any help you can give me,

Dr Bond's reply:
If you want to come off your HRT it is important to wean yourself off if slowly if you want to avoid symptoms returning. There is a factsheet on the ways in which you can do this on the NMAS website. Many people also start taking a nutritional supplement at the same time. One which gives you plant oestrogens is Estroven. This combines 55mg of isoflavones with calcium, vitamins and 70mcg of iodine to boost a flagging thyroid, often a problem at this time.

January 2006

Dear Dr. Bond,
Thank you for your very useful reply about my difficulties in weaning off HRT because of the hair loss I experience. I will definitely try the silica and selenium that you suggest. Can you suggest how I can wean myself off HRT extremely slowly, so that my body doesn't really feel the loss. I've tried several times to come off, but as soon as my hair falls out, I go back on it. I used to be on Prempak C but now I'm on Femoston.

Dr Bond's reply:
I doubt that your hair loss is entirely due to coming off HRT and in any case thinning hair is not going to cause you problems, such as the risks involved in taking HRT. I hope that you are on Femsoton1/10 not 2/10. If you are on 2/10 then you should change to the 1/10. You can then reduce your dosage slowly by taking a tablet every other day so that a month’s supply lasts you for two months. You can then take one tablet every third day and so on. In addition, I suggest that you take some extra iron to help your hair such as SpaTone. When you are off HRT, if your hair loss is still a problem, then you should have your thyroid tested and your oestrogen/ progesterone ratio tested. (For the thyroid ask your GP)

Dear Dr. Bond,
I am a 51 year old woman and have been taking Prempak C for 2 years following a thyroid dysfunction. My T4 was 9.3 but my FSH was normal so the doctor felt that it was the menopause causing the problem rather than the thyroid. It says on the Prempak box that I should have a bleed each month but I haven’t had one for 8/9 months. The doctor says this is OK however I have recently started feeling unwell again, so my thyroid levels were checked again last week. My T4 is 9.8 and my TSH is normal. My symptoms include: nausea, headaches, fatigue, memory loss/ foggy thinking, I have insomnia and when I do eventually fall asleep I wake up with terrible lower back pain which eases as the day goes on. I also have a worsening of hot flushes. I would be grateful for any advice you could give me as I am feeling very miserable with it all.

Dr Bond's reply:
If you have a thyroid problem, as seems to be the case from your blood tests, it needs to be treated with thyroxine not HRT. If anything, the extra oestrogen in the Prempack will make matters worse, as extra oestrogen means your body cannot use your thyroxine properly. You need to see your doctor and discuss this in detail.

Dear Dr. Bond,
I have just read your informative website while searching for information on how to come off HRT, which I have been on for about 10 years! I am now 64. I first went on HRT as being a natural redhead, I could not cope with the embarrassment of hot flushes, nor the discomfort. My GP put me on Estracombi TTS which has never been a problem for me – until recently. My husband’s job has taken us overseas to Sri Lanka where I cannot get patches and my English GP refuses to prescribe them for me. Consequently, I have collected what I can from countries I have travelled to over the last 6 months – mainly Estraderm patches – taken with Norethisterone tablets for 2 weeks of the month. I am very fit – do aerobic exercise 3 times a week, yoga 3 times a week and visit the gym daily. However, since taking my latest concoction of patch and pill, I have felt extremely bloated, my stomach is huge and my breasts are getting bigger by the day and feel uncomfortable. I have also unaccountably put on weight. I have a good balanced diet – am vegetarian but eat beans, pulses etc. I drink occasionally and do not smoke. I would like to come off HRT having been on it so long, and prefer not to put anything unnecessary into my body. Can you suggest a natural answer to my problem? Something that can be posted or obtained in Sri Lanka. Many thanks for your help.

Dr Bond's reply:
Why do you not come off your HRT? The best way is to continue with your Norethisterone tablets but just take them for 10 to 12 days each month and to reduce your Estraderm by cutting strips off the patches until you can do without them. You should also supplement with some Estroven which you can obtain by mail order from Wassen (For information visit their website at www.wassen.com)

December 2005

Dear Dr. Bond,
My wife of 27 years has just turned 50 and is beginning the menopause. Our two grown children left home about two years ago and my wife's mother (age 90) is in the advanced stages of Parkinson's disease. We looked after her at our home for nearly two years but about 3 months ago she went into a Care Home. All these things have left my wife feeling empty and depressed. My wife has always been caring and loving but has recently said she has no feelings for me and wants to live alone. I love her dearly and will do anything to stay with her. My question is, is it possible that the menopause is causing my wife to be like this? Obviously I realise that the other events will be contributory factors to her present state of mind but if there is anything that can be done with regard to the effects of the menopause I would appreciate some guidance.

Dr Bond's reply:
Certainly the hormonal changes that occur at the time of the menopause can have more than physical effects and it is quite possible that your wife’s change of feelings is due to this. I would suggest strongly that your wife goes to see her GP to discuss how she is feeling and perhaps you both might find it helpful to see a counsellor to talk through the problems you are having.

Dear Dr. Bond,
I am 57 years old and have been taking HRT for just under 4 years. I used to take Prempak C, but whenever I tried to come off it, I lost lots of my hair. There was then a problem with the production of Prempak, so my doctor changed me over to Femoston. Because of the change over of hormones, my hair started dropping out in handfuls again. Now my hair is very thin and I feel really worried that I am trapped on HRT and will not be able to come off it. I cannot bear to think that I will risk losing yet more hair by attempting to come off. What do you suggest?

Dr Bond's reply:
Hormonal changes can be the cause of hair loss but they are not the only causes. You should ask your GP to also check your thyroid and iron levels as if these are low they can cause hair loss. I would suggest that you wean yourself off your traditional HRT and consider using the more natural bio-identical hormones. The reason I suggest this is because you would then be using progesterone rather than the chemical progestogen - progesterone tends to improve hair quality. Think how lovely our hair usually is when pregnant when we make masses of this hormone. It is interesting that your hair was good on Prempak because this product is made from the urine of pregnant mares and contains some progesterone.

You should also consider supplements to help your hair’s nutrition such as Silica OK and Selenium ACE.

November 2005

Dear Dr. Bond,
I have been reading your facts sheets with interest and am presently trying to slowly come off HRT. I am using the Aerodoil nasal spray and over the last 5/6 months have halved the dose from a spray in each nostril each day, to only one spray in one nostril each day. I hope that by Christmas I will be able to use just one spray every other day and so on until I feel confident to stop. At moment I get the odd hot flush, but am able to cope with it and will not reduce the dosage any further until I feel I can comfortably without more horrendous symptoms coming back. I take northisterone each month to have a bleed, but could I now take this every other month instead, so that I don't have to have a bleed each month? I am 55 years old and have been on the HRT for just under 4 years. I also think I should take a supplement as you suggest as I'm not feeling that great generally at the moment and very tired. Do you think that would be a good idea? Thanks in anticipation of any suggestions.

Dr Bond's reply:
You are being very sensible in weaning yourself off your HRT. If you are still having a bleed each month when you take your norethisterone then you should continue with it each month. If you only get spotting then you could safely reduce it to alternate months. As you reduce your HRT you should take some supplement to help balance your own hormones and prevent the onset of hot flushes or other symptoms. I would suggest a supplement specifically designed for this that contains IsoFlavones and other vitamins and minerals such as Estroven or Aria.

You should also consider your bone health and ask your doctor to arrange a Bone Mineral Density Screening test for osteoporosis. This should be done now as you come off your HRT and repewated a year later to ensure that you do not lose bone. There is information on this on the web site under osteoporosis and Harley Place Screening.

Dear Dr. Bond,
Hello, I wonder if you could give me some advice please. I am 54 yrs old and had a hysterectomy when I was 38. I was on premarin for 12 years but came off last year mostly because of all the bad press. I have been having lots of symptoms of the menopause - hot flushes, forgetfulness and aching joints but the worst has been having a dry vagina. My doctor has just prescribed me Ortho-Gynest cream, after reading the directions it seems as though this is a form of HRT. Do you advise me to use it or should I try something more natural, I have tried KY jelly and several other remedies but none worked. I would be grateful for your opinion.

Dr Bond's reply:
It sounds as if the surgeons removed your ovaries as well as your uterus when they did your operation when you were 38. The Premarine they gave you is just a form of oestrogen and while it will have kept the flushes and some symptoms at bay it will not have been protecting your bones. Bones need progesterone not oestrogen. I would suggest that you ask your GP to screen you for osteoporosis and to consider taking a supplement such as OsteoMarine to help protect your bones.

For you vagina, yes Ortho Gynest is oestrogen and can be helpful for the vagina. You do not need to worry about the lining of your uterus as you do not have one but it is always best to balance any oestrogen you take with progesterone. This is the natural or bio-identical hormone not the chemical progestogen put into traditional HRT. Progesterone can be prescribed in the form of a cream by your GP if they are willing. There is more information on this subject on one of our fact sheets.

If you prefer not to use oestrogen you could try Phyto-soya vaginal Gel made by Arkopharma. In addition to control the vaginal dryness and other symptoms I would suggest a combination of Estroven, a supplement containing iso-flavones and other vitamins and minerals- details are on the Wassen web site, and combine it with Black Cohosh which has been found to help dryness of the vagina.

September 2005

Dear Dr. Bond,
I am 56 years of age and had a hysterectomy four and a half years ago. I retained my ovaries. At the time the gynaecologist advised an oestrogen implant which I had in place for 6 months, during which time I felt unwell and suffered tremendously from tender breasts. When I sought a replacement implant via my GP he refused as I was not indicated to be menopausal (blood tests). He said I would probably enter the menopause within the next couple of years as this tends to follow on naturally after a hysterectomy. However, I have had no signs of the menopause until the last few months and now it has really hit me. I am having hot flushes throughout the day, night sweats, insomnia, loss of self-esteem and I am piling on weight and seem permanently hungry and thirsty... My experience of HRT does not make me wish to go down this route (particularly as I experienced a thrombosis several years ago following a miscarriage) I have tried Black Cohosh for the flushes but they are having little effect. Also the weight gain and constant hunger and thirst are worrying me. Are these normal symptoms? It would seem from reading your fact sheet that my oestrogen levels are depressed but I am loathe to use HRT to address the problem. Any advice would be welcomed. Finally, my mother had a late menopause but hers went on for about 10 years! Is the length of menopause in any way affected by the hysterectomy?

Dr Bond's reply:
Your symptoms are partly due to lack of oestrogen but many of them relate to a lack of progesterone. The balance of these two hormones is important for women of all ages but especially so at and after the menopause. Our bodies still make some oestrogen from our fatty tissue but once we cease to ovulate the ovaries do not make progesterone. We just make some in the adrenals. This small amount is often not enough to balance the oestrogen and the symptoms you describe occur. I suggest that you read the fact sheets on our web site on progesterone and oestrogen dominance.

August 2005

Dear Dr. Bond,
I have just started my menopause and am fortunate in that I do not have any of the usual problems that many women have at this time. However I have had a Bone Mineral Density Screen for osteoporosis and have been told that my bones are not osteoporotic at the moment but are not as good as they should be. My doctor wants me to consider medication but I would prefer not to go down that route. Have you any suggestions?

Dr Bond's reply:
If your bones are not osteoporotic but just a bit lower than they should be then you probably do not need medication. In any case all the standard medications for osteoporosis can do is to slow your bone breakdown. You then retain old bone which on screening can suggest that your bones are stronger but in fact they are not because this old bone becomes brittle and is at risk of fracture. Also if you stop the medication you then run the risk of losing all the bone you have retained. It is more important that you build up new bone. To build up new bone you need to take weight bearing exercise, have a healthy hormonal balance for your age and take a supplement containing all the nutrients needed for bone health. Weight bearing exercise consists of brisk walking carry a pack on your back. Yoga, dancing, tennis and similar pursuits are all good. If in doubt you should ask at your local gym. If you are not experiencing any of the recognised menopausal problems then your hormones are probably in balance. To ensure that they remain so you should take a supplement such as Estroven or Menopace. These contain nutrients required for your hormonal health as well as isoflavones which are beneficial to bone health. The nutrients you need for bone health are especially calcium and magnesium but these need to be in combination and in correct proportions to each other. They also need vitamins D, E and K to ensure their absorption and utilisation by the body. Another nutrient that is very important for bone health is the Omega 3 essential fatty acids which help bind calcium to the bone matrix. It is important that this is not taken in combination with Omega 6 though as we already have enough of that and an excess is thought to be harmful. These supplements can be obtained in chemists and health food stores. The easiest way to ensure that you take them in the correct combination is to try OsteoMarine which contains them all.

Dear Dr. Bond,
I am very confused as to what to do about protecting my skin when out in the sun. There is so much information about using sunscreens to prevent skin cancer yet I understand that these sun screens will stop me from making the vitamin D which I need for my bones.

Dr Bond's reply:
You are absolutely correct about the effects of sunscreens and vitamin D but it is also important to protect your skin from the harmful effects of the sun. I personally believe that there is considerable over use of these sun screens and protective clothing. This is supported by the fact that many women and children are now being found to be vitamin D deficient. In adults this increases the risk of osteoporosis and in children can result in rickets. The important thing is to protect the skin from burning not to keep every ray of sunshine off it. This can be done by sensible use of sun screens when the sun is very intense and by not exposing oneself to the sun during the peak hours between 12 and 3pm and also ensuring that one does not stay in the sun long enough to burn. Do not go to sleep in the hot sun. It can also be protective to take supplements that protect the skin from the harmful effects of the sun. These supplements are known as anti-oxidants and include the beta carotenes, with vitamins A ,C, E and Selenium. There are good supplements on the market that contain this combination.

Dear Dr. Bond,
I am in my late 40s and have not yet started the menopause but I often feel out of balance and stressed. This may be because I have a busy job, three teenage children and a home to look after. Is there anything I can do to help myself?

Dr Bond's reply:
You certainly have a busy life and I am sure many other women will recognise your situation. The most important thing that you can do to help yourself is to ensure that you have as good a whole food diet as possible, ensure that your lifestyle is healthy by avoiding too much coffee, alcohol and do not smoke. You should also try to give yourself some space each day to unwind and relax. Remember if you do not sometimes put your self first you will make yourself ill and then you will not be able to look after your family as you obviously want to. While you have not yet reached the menopause it is possible that your hormone balance is changing slightly. A good supplement to take at this time is Confiance. This contains the correct combination of vitamins and minerals to ensure that your hormones remain in balance. If you’re feeling at all down or pre-menstrual then a supplement containing the B vitamins and magnesium can be helpful.

Dear Dr. Bond,
I have gone through my menopause very successfully with the help of various nutritional supplements but I have recently developed a problem that is causing me discomfort and affecting my sleep. After I have been in bed for a while my legs become, what I can only describe as wanting to fidget and sometimes I develop cramps. I have tried various suggestions but nothing seems to help. Do you have any suggestions?

Dr Bond's reply:
This is a problem that can be a great nuisance and even painful. It has recently been shown in a survey that extra magnesium can help this problem. I suggest that you take a supplement such as Magnesium-OK which contains magnesium and B vitamins.

Dear Dr. Bond,
I know this page is for women concerned about the menopause - I am not quite there yet but am having some terrible hormone problems which I was hoping you could help me with. I have read about natural progesterone cream (wild yam) from various websites and you seem to be the expert on all of this. I am currently on a waiting list to see an endocrinologist and I hope you can give me some advice! I have been on Diane-35 since I was 18 (now 23). About five months ago I stopped taking these pills since my acne; hirsutism and seborrhoea were no longer a problem. Three months later my acne was back, worse than ever, my hair was falling out rapidly and my hirsutism was getting worse by the week. I panicked, tried to talk to my GP and he put me on a waiting list to see an endocrinologist. I started taking Diane again, as the wait was just too long, and my hair would have been in a really bad state by now! I am really worried that the endocrinologist is just going to give me another synthetic hormone and I will have to be addicted to this for the rest of my life! So I was wondering if you could help me. Can I change Diane-35 for natural progesterone cream? Would this work for my lack of oestrogen and help my androgen overactivity? What would you recommend?

Dr Bond's reply:
First of all I must correct some of your assumptions about Progesterone Cream. First of all it is not Wild Yam. Wild Yam is a herbal hormone balancer in its own right. Progesterone is made from Diosgenin that is contained in Wild Yam and Soya. Secondly progesterone could not help anyone with a lack of oestrogen as it is progesterone not oestrogen and does not make or stimulate oestrogen. If it did we would not give it to women with breast cancer. Progesterone is the hormone that balances oestrogen and is normally given to balance oestrogen dominance. It can also balance testosterone but does not do this as effectively as it balances oestrogen. It certainly would not replace Diane-35 which is a potent anti-androgen. You should certainly see the consultant endocrinologist so that a full assessment of your hormone balance can be made and screening for polycystic ovaries carried out. Once a full diagnosis is made it is possible, and in my view better, to use natural methods to balance your hormones rather than take hormones that just conceal the problem. I would recommend that you consult a good nutritionist and possibly consider using progesterone cream if you have PCO syndrome. In my experience, sadly, the use of hormones such as Diane is the only way to quickly deal with the symptoms, natural approaches can take a long time.

June 2005

Dear Dr. Bond,
Dear Doctor, What estrogens levels are normal for a woman of 59. At the moment mine is 114 - it was 30 six months ago. My doctor recommends Menoring which was brilliant for the first 6 months but after the last one I inserted, 5 weeks ago, I have had headaches, felt very rough really. I am very keen to go on to natural 'hormones', how do I go about it, as I think I would like to come off this HRT as also my blood pressure is high (always had low blood pressure) and my cholesterol is 7.1. Something is wrong somewhere - can u help please?

Dr Bond's reply:
There are no correct levels of oestrogen. A laboratory will give a range of figures when you have a blood hormone test done that indicate what the normal range is. This normal range varies with different times of the menstrual cycle. However these references ranges are very large and if one is not in the range it may not indicate a problem because every one is different. After the menopause, it becomes even more complicated. Again the laboratory will give a reference range into which they consider a person should fall. The problem here relates to the fact that the reference range is large. If a woman had high oestrogen levels in her younger years and she is found in the menopause to have a low level of oestrogen, but within the so called normal range, she may have sweats and flushes and feel awful because she needs higher levels. Equally, a woman who always had low levels of oestrogen would feel fine on these lower levels. I personally find using these laboratory test and levels of oestrogen to be limited in their use. By far the best guide to whether or not your oestrogen levels are normal is how you feel. It is often forgotten that women do not need high levels of oestrogen after the menopause and putting the level up to higher levels can be dangerous.

March 2005

Dear Dr. Bond,
I am 34 years old and both my mother and grandmother went through their menopause at the age of 35 and 36. I have been suffering very badly with irregular and heavy periods and recently had the Mirena coil fitted to try and resolve this. I have had severe mood swings, extremely tender breasts, dry vagina and lack of libido. Could I be experiencing early menopause, and if so, what can I do about it?

Dr Bond's reply:
I think it is very unlikely that you are having an early menopause at the age of 35, although it is not impossible. You are certainly suffering from some hormonal imbalance. Many of the symptoms you describe relate to what is known as oestrogen dominance. This can occur in the mid thirties if ovulation does not take place every month. I would suggest that you get your oestrogen and progesterone levels measured in the second half of your cycle. Your doctor can do this, or your can order a hormone testing kit from Harley Place Screening. Meanwhile, I would suggest that you supplement your diet with a specifically designed supplement like Magnesium OK.

Dear Dr. Bond,
I'm 55 years old and had an early menopause in my early to mid forties. I have been on Prempak for at least 10 years and fear coming off for two main reasons. One is that my mother - and other women in the family - had very bad osteoporosis. My mother, in particular, was bent double before she died and had a very bad time. I persuaded my doctor to send me for a bone scan and currently this is fine but will that change if I come off HRT? My other very real worry is that if I come off HRT, I will suddenly look much older in face and body. This is enough to make me stay on it at present. I am aware of the current take on health risks but would like to stop if I can support myself in doing this in the right way. Thanks

Dr Bond's reply:
It is important that you realise the risks involved in taking Prempack long term. Regarding the osteoporosis question you say that our bones are alright at the moment. What you need to know is that having been on oestrogen all this time your bones will have been retaining old bone rather than building up new bone and there is a risk that this old bone will become brittle. Also if you stop your oestrogen you could risk losing all this retained bone and becoming osteoporotic. If you are happy and your GP is happy for you to stay on the Prempack C then provided you are have regular mammograms, cervical smears as well as blood pressure and cholesterol check, you could stay on it. If you come off it, your must wean off it and take measures to protect your bones. This could include a good bone supplement with Omega 3 fatty acids plus natural progesterone.

Dear Dr. Bond,
I am in my 60s and have recently been diagnosed as having osteoporosis. I have now read quite a bit about this problem and realise that it can have a familial link as well as being related to many other things. I would like to ask you what sort of advice I should give my daughter who is 38 and my granddaughters who are in their early teens?

Dr Bond's reply:
You are absolutely correct in that there is often a family link with osteoporosis but there is a great deal that can be done to prevent osteoporosis from developing. With regard to your daughter, it would be sensible for her to have a screening for osteoporosis. She would then know whether or not her bones are normal for her age or if she already has bones that are not as strong as they should. If her bones are normal, then she should continue with a good healthy balanced diet, do a moderate amount of weight bearing exercise and possibly supplement with calcium, magnesium, vitamin D and Omega 3 Fatty acids. There is only one on the market that contains all these nutrients in one capsule and that’s OsteoMarine. If her bones are not as strong as they should b,e then she should consult a practitioner who can help her and also look at our fact sheet on osteoporosis. Your grand daughters needs to remember the importance of a good balanced diet containing nutrients needed for bone, to take exercise and avoid both excess weight gain or loss. They should also realise that when the time comes for contraception the pill is not good for bone health.

Dear Dr. Bond,
I have been diagnosed with osteoporosis and am post menopausal. My doctor says that I cannot do anything to build up my bones now as I am too old but that he can give me medication to stop them becoming worse.

Dr Bond's reply:
I am afraid that what your doctor says is not strictly correct. He can indeed, and probably should, give you some medication such as Fosamax to slow your bone break down but there is a lot you can do to build up new bone. Our bone metabolism does not stop just because we become older. You need to look at your diet and make sure that you are eating enough protein and that it contains the nutrients needed for bone growth. These are calcium, magnesium, boron¸ silica, zinc, vitamins D and K and Omega 3 Fatty Acids. In addition you should take a bone supplement containing most of these, such as OsteoMarine. In addition you should try to take some weight bearing exercise. It could also be useful to supplement with some natural progesterone cream.

Dear Dr. Bond,
I am a young man in my late 20s. I have recently had two fractures as a result of relatively minor trauma. My grand mother had osteoporosis and I asked my doctor if I could have the same problem but he just laughed at me. Should I be concerned?

Dr Bond's reply:
You are absolutely right to be concerned. Osteoporosis affects men as well as women and anyone who sustains a fracture as a result of minor trauma should consider the possibility that their bones are not as strong as they should be. I suggest you arrange an osteoporosis-screening test either via your doctor, Harley Place Screening or similar organisation. If your screening shows that your bones are not as strong as they should be then you must start taking a bone supplement such as OsteoMarine or Osteocare plus Omega 3 Fatty Acids, and take up some weight bearing exercise. This could be using weights in a gym or running. This should enable you to build your bone strength to normal within about 24 to 36 months. If it does not, then you must see a specialist to see whether or not there is some other contributing factors.

Dear Dr. Bond,
What is osteoporosis? I have heard that you can have it without knowing and that it can kill you.

Dr Bond's reply:
Osteoporosis is a condition that exists when your bones are not as strong as they should be therefore increasing the risk of fracture. It can be detected by having a bone density screening test. If your bones are weak, then you can take specific supplements, improve your diet, take upexercise and if necessary, take special medication. The condition can not only be prevented from becoming worse but can be cured. Regarding osteoporosis killing people, it does not. What can happen sometimes is that as a result of sustaining fractures of the hip or spine, other conditions can result and these can be life threatening.

January 2005

Dear Dr. Bond,
Having recently come off HRT, I suffer terribly from hot flushes. My doctor recommends that I increase Estroven to 2 tablets per day (one morning + one evening). How long can I continue with 2 tablets per day? Is there anything else I can do to help?

Dr Bond's reply:
There is no reason at all why you should not take 2 Estroven tablets per day for up to 3 months, and then reduce the dose to 1 tablet a day again. In order to maximize utilization of isoflavones you could consider taking a probiotic product for a while, which should be available from your local health food store. If you did not wean off your HRT you will have problems. If these are very bad you could go back on your HRT to settle the flushes and then wean off the HRT slowly taking Estroven as you do. There is a fact sheet on our web site about coming off HRT.

Dear Dr. Bond,
I am 40 years of age and my periods have stopped about 5 years ago for no apparent reason. Does this mean I am menopausal? I don’t seem to have any of the symptoms?

Dr Bond's reply:
35 is very young for your periods to stop. You do not say whether you had any other problems at the time or whether you had been on the contraceptive pill. If you are having an early menopause then you have to consider your increased risk of osteoporosis and have a bone mineral density scan.

Dear Dr. Bond,
I recently read an article in a newspaper to say that sunbed users have stronger bones. I am worried about skin cancer? Can you recommend something else instead to help keep my bones strong?

Dr Bond's reply:
There should certainly be a benefit for your bones by exposure to sun and sun beds because sun acts on the skin which then makes active vitamin D that is needed by the bones. I would not recommend sun beds as a way of avoiding osteoporosis. The first thing you should do is to have a bone mineral density scan to see if you are at risk of osteoporosis. If your bones are OK then just maintain a good diet or supplement. If your bones are not as strong as they should be then you must take a good bone supplement, exercise and maybe consider using progesterone cream. Consult our fact sheet on osteoporosis.

Dear Dr. Bond,
I am going through the menopause and am concerned that I have not exercised most of my life. What kind of exercise would you recommend for me, at this stage in my life to help me optimise my bone strength?

Dr Bond's reply:
There is considerable evidence that the best form of exercise for strengthening bones is yoga. Skipping, dance and playing tennis are all excellent. However you must also ensure that you are obtaining all the nutrients your bones need by taking a good bone supplement.

November 2004

Dear Dr. Bond,
I am in my early forties and my periods are still regular so I do not think I am approaching the menopause but I have noticed that my PTM is becoming much worse especially if my period is a bit delayed. Is there anything I can take to help avoid this?

Dr Bond's reply:
This is a common problem as women reach their forties and it relates to the natural hormone changes that occur at this time. Although you still have regular periods the chances are that you do not ovulate every month. This is why it becomes more difficult to become pregnant, as you become older. If you do not ovulate then the hormone progesterone, which is normally secreted by the ovary to prepare your body for a pregnancy, is not produced. This means that your oestrogen is not balanced and you experience the symptoms associated with PMT. If you take a supplement containing vitamin b and magnesium such as Magnesium OK you will find that your symptoms will be greatly alleviated. A good healthy diet and general life style are also important.

Dear Dr. Bond,
I am in my early fifties and am experiencing symptoms that my reading tells me are associated with the menopause. My periods are also erratic but my doctor has done a test to measure my FSH and he tells me that it is normal and that I am not starting the menopause. This does not make sense to me.

Dr Bond's reply:
The problem with the single blood test for FSH (Follicular Stimulating Hormone) is that it varies from cycle to cycle. If your doctor measured it during a cycle when you had ovulated, it would be normal. However if it had been measured during another cycle when you had not ovulated it would have been raised and he would have told you that you were entering the menopause. This test can sometimes be helpful but more often than not too much reliability is placed on it. It is forgotten that it is only telling you what is happening that cycle. If you have symptoms suggestive of the menopause at your age, then the odds are that you are entering your menopause. You should ensure that you are leading a healthy lifestyle and eating a good diet. In addition you should take a supplement designed to help at this stage of your life. It should contain specific vitamins and minerals combined with isoflavones. A good supplement that supplies these is Estroven.

Dear Dr. Bond,
I am in my late thirties and having been taking the contraceptive pill since I was nineteen. I stopped taking the pill six months ago because I wanted to have a baby but I have not yet had a period and my doctor has done a blood test and told me that I have had an early menopause and need to take HRT. What can I do?

Dr Bond's reply:
The first thing is not to panic. It is not uncommon for periods to be delayed for many months when you stop taking the pill if you have previously been on it for a very long time.This is because the ovaries have been suppressed and they need time to recover. The test your doctor has done will have shown that you have not yet started to ovulate. This does not mean that you will never ovulate again. What you have to do is to rebalance your body and hormones. To do this you must make sure that your lifestyle is healthy, do not smoke or drink alcohol, eat a healthy whole food diet, do some exercise and take some natural remedies to help balance your hormones. Mexican Wild Yam is particularly useful at this time. It can also be helpful to see a homeopath or acupuncturist who can help to balance your system. What ever you do, you should not take HRT as this will suppress your ovaries even more.

Dear Dr. Bond,
I am in my late thirties and my periods stopped about a year ago. My doctor says that I have had an early menopause. He has checked my blood on several occasions because he says that just doing it once is not enough. He says I am not ovulating and that my oestrogen levels are also low. I am not surprised at this as the same thing happened to my mother, an aunt and my older sister. My doctor has said that I should take HRT but I am anxious about this as well as being anxious as to what might happen if I do not.

Dr Bond's reply:
Your doctor is probably correct in his diagnosis because he has tested your blood levels on several occasions and you have a family history of early menopause. One of the main problems of an early menopause is the increased risk of osteoporosis. However traditional HRT will not do a great deal to prevent this and there are now recognised side effects to taking HRT long term. In addition, a woman as young as you are, will probably want to remain sexually active and the low oestrogen levels can lead to vaginal dryness and shrinkage. To maintain a normal hormone balance for your age you should consider taking bio-identical hormone replacement therapy. This involves taking hormones that are identical to those that your body makes as well as taking them in a dose specific for you. Traditional HRT only contains one of our three oestrogens and it does not include progesterone but a synthetic form called progestogen. You should also have an osteoporosis screening test to see how strong your bones are now and to keep an eye on them for the future.

Dear Dr. Bond,
I am very confused. A year ago my doctor told me to stop HRT because of the reports of certain trials which had been stopped because of the increased risks of breast cancer. She also told me that these trials also suggested that HRT did not have the benefits that had been thought in relation to prevention of heart disease and dementia. I stopped HRT and I have to admit that I do not feel as well as I did and my sweats and flushes have returned. The doctor now tells me that I can go back on to HRT because the results of the trials were not interpreted correctly and it is now thought to be relatively safe for 5 years. What do you think?

Dr Bond's reply:
I am not surprised that you are confused, many doctors are as well. I personally believe that HRT should be avoided if possible but let me set out for you the situation as it is considered to be at the moment. The advantages of HRT are:

1. It is effective in reducing hot flushes, sweats and vaginal dryness. It can also help relieve insomnia and depression if these are hormonally related.
2. It can reduce bone loss in osteoporosis but this benefit only last while the HRT is being taken. When the HRT is stopped, bone loss increases and the osteoporosis can revert to being as severe as it would have been, had the HRT not been taken.
3. There is some evidence that suggests that HRT may reduce the risk of colon cancer.

On the other hand, the disadvantages of HRT are:
1. There is a significant increase in the risk of breast cancer. This is greater with the combined HRT than with oestrogen alone.
2. There is an increased risk of strokes
3. There is an increased risk of coronary heart disease in the first year of taking HRT and no benefit is seen in later years.
4. There was no evidence to show any protection from dementia or mental deterioration
5. There was an increased risk of venous thrombosis
6. There was an increased risk of uterine cancer is oestrogen was taken on its own but no increased risk with the combined HRT
7. There was an increased risk of ovarian cancer in women who took oestrogen only following a hysterectomy where the ovaries were retained.

The medical consensus of opinion is that HRT is not without risks but that if menopausal symptoms are severe and nothing else will help, then taking HRT for up to 5 years is all right provided all the risk factors are considered especially in relation to the individual. It may also be considered in severe osteoporosis if non of the other medications are acceptable.

What is not considered here is the possibility of using bio-identical HRT which does not seem to carry the same risk factors, although extensive trials have not been carried out as for traditional HRT.

The best option for menopausal symptoms first of all is to try the complimentary route using food supplements, herbal preparations, acupuncture, etc. and to only consider any form of HRT if these do not make life bearable.

October 2004

Dear Dr. Bond,
I am 45, 5'4” tall and I now weigh 75kg. I am currently being prescribed Cetririzine Hydrochloride and Beclomethasone Dipropionate Aqueous Nasal Spray. I have also been taking red clover for almost three months and ever since I have felt some form of pressure on the part of my throat where I believe to be the thyroid gland. I have also noticed that even though I am physically active, I have been gaining too much weight and haven't been able to shed it off. I have healthy eating habits and take supplements alongside Novogen, red clover, Menopace, flaxseed oil, primrose oil, garlic pills and turmeric. Can red clover affect the thyroid gland? Is it linked to weight gain? Can it be classified as a natural HRT? Can I take all these supplements alongside my prescribed medication without affecting my health or gaining anymore weight? Please advise.

Dr Bond's reply:
You do not say why you are taking the medication that you list but I suspect that you have some allergy. You should consult your own doctor as to what supplements you can take with your medication and also ask him or her to check your thyroid. Red Clover is a phyto-oestrogen and is not classified as HRT. Natural HRT strictly speaking refers to bio-identical hormones.

Dear Dr. Bond,
I am 60 and came off Climess HRT tablets in August 2003 after 10 years. I was not told by my doctor about coming off gradually and just stopped. I am worried that I may have caused some harm by doing so. Could you advise me please? I am taking Tofu pill which has greatly reduced the hot flushes that returned, and omega 3 fatty acids. My main worry now is total loss of libido and great tightness and dryness of the vagina making sex painful. I do take a vitamin and mineral supplement, also alpha lipoic acid and L-Carnitine, Co-enzyme Q10, vitamin B complex, medeen and zinc, do you think I am over doing it? I suffer from peripheral neuropathy. I am not diabetic. Should I take calcium supplements?

Dr Bond's reply:
You will not have done yourself any harm by coming off HRT cold turkey. You have done the correct thing by taking supplements to help your symptoms. Calcium supplements on their own are a waste of time. If you are concerned about your bones then you should ask your doctor to arrange for you to be screened for osteoporosis. If this shows a problem then you need to take a specifically designed bone supplement that contains all the vitamins and minerals you need. Regarding your vaginal problems, I would suggest that you try a phyto-soya vaginal gel and increase your vitamin E intake.

September 2004

Dear Dr. Bond,
I am 39 years old and am experiencing some symptoms of menopause - inability to control my body temperature before and during a period, incredibly painful breasts, dry vagina, mood swings and hugely irrational irritability and my periods happen when they like! I wonder if I should I see my GP but I really don;t want to take up a valuable medical slot if this is simply my next stage in life. I am otherwise well if rather overweight and would appreciate any help you might be able to offer

Dr Bond's reply:
Dear Cheryl, The symptoms you describe are typically of those caused by the hormonal changes that take place prior to the menopause. Even though these changes are part of a normal process, there is no need for you to suffer and not have any help. Going to your doctor might help but the chances are they will suggest HRT or similar. I would suggest that you take a look at your whole life style because diet, stress and exercise, or lack of it, can all play important roles at this time. Make sure that you eat a good balanced diet that includes as much organic food as possible. Also reduce you intake of coffee and alcohol. It can also be useful to take a general vitamin and mineral supplement. Stress can always throw your hormones out of balance. If this is a problem for you then try to handle your stress better. Take up some form of relaxation or meditation and possibly take an adrenal support formula. Exercise is important for the general metabolism and to help your bones stay strong. In addition to the general vitamin and mineral supplement and the adrenal support formula I would suggest an isoflavone supplement such as Estroven together with some Magnesium combined with vitamin B6 for the moods and the stress. Confiance is a particularly good combination.

Dear Dr. Bond,
I am 48 years old, with no obvious menopausal symptoms to date. My periods are still regular although becoming light. I have suffered for many years from chronic cystic breast disease. Despite a strict and consistent regime of a careful vegetarian/fish, no dairy diet, regular exercise, use of fish oil/evening primrose oil and more recently soya products and isoflavones supplements, there has been no significant improvement. If anything the pain and discomfort is worse. Regular breast screening shows only multiple cyst formation. I have read extensively about breast problems, particularly cancer, and therefore I am aware of the significant role oestrogen can play in its development. Presently my hormone profile reveals a drop in progesterone levels and although my oestrogen level is considered within the normal range, obviously this imbalance has made me oestrogen dominant. If this profile status remains for any length of time, I am concerned about the consequences. John Lee's work on the use of natural progesterone sounds like an exciting solution although Marilyn Glenville, 'Natural Alternatives to HRT' is not supportive of his recommendations. I find this all very confusing and would appreciate some advice on how to ease my way through the menopause whilst also making an informed decision in order to protect myself, as much as possible, from the development of breast cancer.

Dr Bond's reply:
Dear Brenda, You are absolutely correct in saying that you think your problems relate to oestrogen dominance. So many people find this concept difficult to understand, especially when they know that their oestrogen levels are falling. However as you know, the importance lies in the ratio of oestrogen to progesterone. I think it would be well worth your while to try some natural progesterone cream. I know some people are not completely happy with the use of progesterone in the form of cream but this is often because they do not understand that the progesterone is bio-identical. Even though it is made from Wild Yams or Soya, the molecule of progesterone that results cannot be differentiated by a chemist from a molecule made in your own body. Because of this, the body treats it just as it would if it had made it itself and it doesn’t accumulate in the body. The progesterone creams has been used for about 30 years without any reported side effects and I really believe that, if it was a problem, we would have seen them by now. It is best if you can have the cream prescribed by a doctor who is familiar with its use rather than self medicating.

Dear Dr. Bond,
There was recently a TV programme that seemed to suggest that taking extra vitamins and minerals was dangerous. Did you see this program and what did you think of it?

Dr Bond's reply:
Yes I did see the programme and found it interesting. The main assumption they made, which I consider to be untrue, was that you could obtain all the vitamins and minerals you need from your food. This might be true if you grew all your food yourself in a pollution free environment and mineral rich soil but that cannot be said of modern food. Some of the side effects of vitamins that were referred to in the programme were worrying and what struck me was that the evidence they presented was not very conclusive and it was not absolutely clear that taking those specific vitamins was what cause of the problem. Other factors that often contribute to the problem, were not mentioned. They also seemed to be discussing instances where high doses of individual vitamins had been taken. This is never a good way to take your vitamins. Vitamins and minerals are always best taken in specifically designed supplements for specific conditions. For example, if taking antioxidants, a combination of Selenium with vitamins A, C and E is better than taking a high dose of vitamin E because the combination found in these specific supplements are low dosage and designed to work together.

Dear Dr. Bond,
I am 38 years old and am beginning to experience occasionally irregular periods. Am I starting the menopause?

Dr Bond's reply:
I think it is unlikely that you are starting the menopause at 38. The average age for periods to stop is 50 with any time between 45 and 55 being considered normal. It is not uncommon for periods to become erratic in the late thirties and this is not a cause for concern. It relates to the fact that when you reach that age you may not ovulate every cycle, and even if you do, the hormone balance particularly in the second half of the cycle is sometimes our of balance. These changes are aggravated by stress. I would suggest that you take a supplement product containing some magnesium and vitamin B6, such as Magnesium OK, to help balance your hormones.

Dear Dr. Bond,
Can a blood, urine or saliva hormone test tell me whether or not I am menopausal?

Often, if you go to your doctor complaining of problems that suggest you might be menopausal, he will do one of these tests and tell you whether you are or not menopausal. Unfortunately, these tests can only measure the hormones in the month in which you have the test done. As you approach the menopause it is not uncommon to have one month when your hormones reflect a menopausal picture followed by one in which the hormones are as normal as they were when you were in your twenties. These tests cannot give you a definite answer. All these test can do is, together with the information on how you feel and what your periods are doing, give you an indication as to whether or not you are approaching the menopause.

Dear Dr. Bond,
I have finished my periods and no longer have any menopausal problems except that I have noticed that my skin is more wrinkled and I seem to be more sensitive to the sun. My doctor has suggested a low dose of HRT but I do not want to take any hormones. Can I do anything about this?

Dr Bond's reply:
I do not think that taking HRT is the answer to this problem. The skin changes that you are experiencing are due to an increase in substances called free radicals. These are substances that are responsible for most of the changes we associate with ageing. They are dealt with in our bodies by substances known as antioxidants. You can increase your intake of these by taking a supplement containing Selenium, vitamins A, C and E.

August 2004

Dear Dr. Bond,
I am, I think, a very fit woman in my late forties. I have never had any problems with my periods and am anxious to avoid any problems at the menopause. I certainly do not want to take any hormones. Is there anything I should be doing now?

Dr Bond's reply:
You have obviously led a fit healthy life style and should continue to do so. If you are not taking a nutritional supplement product, you could consider Confiance which is designed to maintain good hormonal balance. It is also sensible to have a screening test for osteoporosis to make sure that your bones are strong as now is the time to deal with them if they are not.

Dear Dr. Bond,
I am 49 and I think my periods have stopped. I have some sweats and flushes but not too bad. My doctor says I should consider HRT as my mother had osteoporosis but I am not happy about this.

Dr Bond's reply:
If your doctor is concerned about you developing osteoporosis, rather than just dish out some medication that will not do very much good in the long run he should send you for an osteoporosis screening. If your bones are alright now then the screen can be repeated in a few years time. If you are worried about developing osteoporosis in later years, this is a good time to start taking mineral supplements for bone and exercise.

Dear Dr. Bond,
I have reached my mid thirties and am, I believe, fit and well. However I have noticed that my skin is not as elastic as it should be and my nails are dry. What can I do about this?

Dr Bond's reply:
The changes you mention are due to what are known as free radicals. These are reactive particles that form in our tissues as a result of toxins and internal processes in the body and can cause what is known as oxidation in our tissues. These changes are responsible for many of the changes we notice as we age- they can be described as similar to metal going rusty. The effects of these free radicals can be countered by taking antioxidants nutrients. Selenium is a very powerful antioxidant and it is a good idea to supplement it because our diets are very low in it. I suggest you combine Selenium with the vitamins A, C and E.

Dear Dr. Bond,
I have read many articles that explain the advantages of eating soya foods to prevent menopausal problems. While this is probably true I find that I cannot eat these foods as they upset my digestion. Can I obtain the advantages of these foods any other way?

Dr Bond's reply:
The reason soya food have the effects they do in preventing menopausal symptoms is because it contains iso-flavones. Generally, soya foods are easy to digest but it you are having digestion problems, it might be a good idea to try different forms of it. For instance, you can buy silken tofu, which is plain, but you can also buy it marinated. (Read the label to ensure the product is not made with isolated soya). You can also eat it in prepared foods like burgers and sausages. Go for organic ones if you can, to avoid food chemicals. Other type of soya foods are miso and tempeh. These are all available from health food shops and some supermarkets. If you still experience digestion problems after doing this, you can obtain isoflavones in specially prepared supplements. Estroven is one example. The advantage of obtaining you isoflavones this way is that you know how much you are getting each day.

Dear Dr. Bond,
I know it sounds vain but I hate the fact that since I had my menopause I have developed brown age spots. I have been told that taking oestrogen will improve my skin but would prefer something with less side effects.

Dr Bond's reply:
Recent research has found that these spots as well as skin cancer occur most commonly in women who are low on Selenium. In the UK most people are low on Selenium because our diets are low in this essential nutrient. I would suggest therefore that you supplement your diet with Selenium. Incidentally, selenium works best if combined with vitamins A, C and E.

Dear Dr. Bond,
I am in my late forties and am sure that I am approaching my menopause. My periods are irregular and fairly heavy but nothing that bothers me. I went recently for my cervical smear and the doctor said that I had a fibroid. I went to the hospital where they recommended a Hysterectomy and removal of my ovaries. This seems rather drastic to me.

Dr Bond's reply:
I would agree with you. If you are not aware of the fibroid it is probably not all that large so it should not cause any pressure problems. Your periods are heavy but do not bother you and will probably stop in a few years time. When that happens your fibroid will begin to shrink naturally. I would suggest that you postpone the surgery and make sure that you take a good supplement product which includes iron, to prevent anaemia, and await your menopause.

Dear Dr. Bond,
Hi. I have just come off HRT patches which I weaned myself off and I am now suffering bad night sweats, also during the day. I have a family history of osteoporosis and would like to know which supplements to take to get me past this.

Dr Bond's reply:
Well done for weaning off the HRT. To help with the sweats and flushes I suggest that you take a supplement containing isoflavones. One of the highest dosage is Estroven on which trials done last year showed an effect better than placebo in dealing with flushes and night sweats. You could also try some Red Clover and Tincture of Sage. The isoflavones will help your bones as will taking a supplement specifically designed for bone nutrition together with some Omega 3 Fatty Acids. It would be sensible to obtain a bone density screening to check the density of your bones now and to repeat it in a year to eighteen months. The reason for this is that oestrogen in HRT retains old bone and when you stop the HRT this bone may come away. If you do start to lose bone you could consider using progesterone cream as this can build up new bone.

June 2004

Dear Dr. Bond,
I have recently had glandular fever and I am very keen to improve my immune system. I am taking Echinacea Root Extract but wondered if there was anything else I should be taking?

Dr Bond's reply:
You are very sensible to want to improve your immune system after glandular fever and of course it is useful for everyone to consider this. There has very recently been a report from the University of Liverpool which shows that increasing your intake of selenium can improve your immune system. This is a mineral many people are lacking because of a switch in imports from selenium rich cereal grain grown in North America to selenium poor varieties from Europe. Selenium is also known to fight free radicals and thus protect against signs of ageing and cancer. Selenium is absorbed best if you take it in combination with vitamins A, C and E for better immune support and antioxidant protection. There are specialist products available in pharmacies that contain this combination.

May 2004

Dear Dr. Bond,
I was diagnosed with breast cancer a month ago and I am currently having radiotherapy for it. Because it is a hormonal cancer, I cannot carry on taking HRT. Are the phytoestrogens contained in Estroven safe to use in these circumstances?

Dr Bond's reply:
There is still considerable debate as to whether or not it is safe for women with, or who have had breast cancer, to take any form of phyto-oestrogen. It is advisable to discuss your particular case with your oncologist.

Dear Dr. Bond,
My doctor has recommended carrying on taking HRT because I have been diagnosed with osteopenia. I am so concerned about it I have agreed to do it. Is it ok for me to take supplements to help with the menopause symptoms and to support bones even though I am taking HRT?

Dr Bond's reply:
The current recommendation is that the taking of HRT for osteoporosis or osteopenia in not valid. The official reason for this is that the risks of breast cancer outweigh the possible benefits of taking the HRT. The oestrogen in HRT does not build up new bone. It only, possibly, slows the break down. This so called benefit will only last while you take the oestrogen. The best approach to osteopenia is to build up new bone. This can be done with weight bearing exercise (see our fact on Osteoporosis fact sheet on this) a good bone mineral supplement to build up bone and Omega 3 Fatty acid to slow breakdown. It may also be beneficial to use progesterone cream. Consult our fact sheets on What is Osteoporosis?, Osteoporosis Screening and The Role of Natural Progesterone.

Dear Dr. Bond,
I have always tried to manage the menopause in a natural way because I don’t agree with taking HRT and try to avoid taking any kind of medication whenever I can. I have been supplementing my diet with different products; one of them is Confiance, the one you recommend on your fact sheets. I have been doing quite well until recently. For some reason the effectiveness has stated to wane. What could be the reason for it?

Dr Bond's reply:
It may be that your own hormonal balance is changing as you go through the menopause. I would suggest that you continue with Confiance but take it on alternate days with Estroven and gradually transfer to Estroven.

Dear Dr. Bond,
After taking HRT to help me with my hot flushes for 10 years, I came off it 6 months ago and the hot flushes came back worse than they were before. I have been taken products containing isoflavones, not Estroven, for about 2 months now and they haven’t made any difference. What else can I do?

Dr Bond's reply:
The flushes are due to the fact that you came off your HRT suddenly. You should always wean off and as you do so introduce a supplement such as Estroven. I suggest that you try Estroven, as trials have shown it to be effective in dealing with hot flushes. You need to take it for at least 6 weeks. You should also include a supplement to support the adrenals to help the body deal with stress. See our fact sheet on coming off HRT.

Dear Dr. Bond,
I am 58 and I had both ovaries removed when I was 35 after being diagnosed with endometriosis. I was told by the consultant to come off HRT immediately because of chronic groin pain. I came off immediately about 6 months ago. Everything was ok but I am now getting chronic bone ache all over my body especially in my groin, hips and arms. My GP doesn’t understand and I’m not getting much help from the consultant. Can this be caused by stopping HRT? Can the supplements you recommend help with this problem? v

Dr Bond's reply:
I doubt that your aches and pains are due to coming off HRT although that may aggravate the problem. I suggest you take Omega3 Fatty acids to help to lubricate the joints. Some Selenium ACE to help the immune system which is sometimes involved. You could also take some Glucosamine together with a supplement containing Boswellia, Curcumin and ginger as these are natural anti-inflammatories.

April 2004

Dear Dr. Bond,
Could you please advise which natural menopausal treatments are suitable for use with Thyroxin. I am 43 years of age and following several years of perimenopausal symptoms (erratic and absent cycle, hot flushes, severe fatigue, insomnia and mood swings) I was diagnosed as being hypothyroid in April last year. At the time, blood tests showed T4 levels at 5.7, LH at 31.6 and FSH at 62.2. A test this month showed levels of T4 at 14.5 (taking 75mcg of Thyroxin), LH at 37.1 and FSH at 80.5 leading my GP to confirm me as menopausal since the gaps in my cycle have extended with the most recent being over 6 months, following only four light periods in the previous year. I should also add that I have not had children and so there is an emotional loss connected to this diagnosis. I eat a very healthy diet, drink only water, no alcohol and am a non-smoker. Over the past few months the signs have intensified with mood swings, depression, hot flushes, chest pains and sleeplessness increasing to the point where my daily activities have been compromised. These have been checked out with my GP who is being helpful with offers of HRT, a bone scan and counselling. However, I would prefer to avoid HRT and use natural and holistic remedies, but am aware that some may be contraindicated due to my hypothyroid state. Any advice you can give me would be very much appreciated.

Dr Bond's reply:
You are very sensible to resist taking HRT. Although your blood test indicated that you were possibly menopausal you should not take this as absolute truth. You should remember that this was a single blood test and will reflect what your hormone levels were at the time. I suggest that you read our fact sheet on premature menopause and you will see that a number of women are diagnosed as menopausal when they are not. Any women who is not ovulating, for what ever reason, is very likely to have a high FSH. This does not mean that you will never ovulate again. It is interesting that you have also recently been diagnosed as being hypothyroid. It could be that you have an oestrogen progesterone imbalance making you what is known as oestrogen dominant. We also have a fact sheet on this. My suggestion would be that you do a saliva hormone test via Harley Place Screening (see contact details on the NMAS website site) It may be that natural progesterone is actually what you need.

Dear Dr. Bond,
I am 55 years of age and had a hysterectomy nearly five years ago but still have my ovaries. I was put on Oestrodol tablets but have weaned myself off gradually, taking my last tablet a month ago. Since then I have started the hot flushes and night sweats which are getting worse and I generally feel awful especially not sleeping properly and also having a sinus infection does not help. My query is that I had suspected gall stones last year but the hospital finally decided I have IBS assisted by nerve ending pain (from a back operation 15 years ago). Do you think Black cohosh could help with flushes and sweats? I appreciate it takes a while to get into the system. Can you suggest a better option please?

Dr Bond's reply:
You do not say whether you had started your menopause or not when you had your hysterectomy but I suspect that you had not. I can never understand why women are given oestrogen following a hysterectomy when the ovaries have been left. After all, it is the ovaries that make oestrogen, not the uterus, and there is no reason to assume they will work any differently just because the uterus has been removed. Weaning off oestrogen as you have done is always better than stopping it suddenly. The weaning process can take several months. During the weaning process it is helpful to take an isoflavone supplement, such as Estroven. In fact, I would suggest you start doing that now. Estroven has been shown in trials to help sweats and flushes but it can take up to four or six weeks. Red clover can also help.

Dear Dr. Bond,
I am 31 years old. I have been having symptoms over the last year that I've just pushed to the back of my mind. These include 12 periods in the last six months, loss of libido, vaginal dryness, tender breasts, hot flushes, memory problems, tiredness and acne. I was under a lot of stress in 2003 and experienced a bereavement. To start with I put it down to that, but I can’t understand why I'm still having problems. Someone suggested early menopause, I have to say I laughed. Medical History, I haven't taken the contraceptive pill in 8 years due to them making me bleed for 3 weeks in 4. I have 3 children, 9 years, 7 years and nearly 6 years old. I have suffered with depression/post-natal depression on and off for the last 13 years, this started with insomnia. Even now I still have the odd night, not something I really worry about. Whenever I've been to my Doctor with any of my symptoms, I just keep being told to come back in 6 months if I'm still having problems. Could this just be a hormone imbalance or could last years stress be the cause. I've put the premature menopause idea at the back of my mind due to my age. Should I insist on some tests from my Doctor? Any suggestions or ideas would be wonderful. Thank you.

Dr Bond's reply:
You are certainly experiencing a time of hormonal imbalance. It could be an early menopause but is more likely to be due to the stress you have been going through recently. The symptoms are classically those of oestrogen dominance (see our fact sheet on this). I would suggest that you ask your doctor for some tests. It would be useful to check your blood generally to make sure that your are not anaemic and that you do not have a thyroid problem. You should also ask him to check your hormone balance. In particular, he needs to check your FSH (this indicates how well you are ovulating in the particular cycle). This should be done in the first half of your cycle. In the second half of the cycle he should check your oestrogen and your progesterone. This will indicate whether or not you actually ovulated and can also be used to check whether or not you are oestrogen dominant. If your doctor is not happy to check the hormones in this way they can be checked using saliva. See sheet on Harley Street Screening on www.nmas.org.uk

Dear Dr. Bond,
I am concerned about coming off HRT because I am afraid it might make my hair thinner (I have a lot of hair at the moment), make my breasts sag (I have always had good breasts) and I might lose the “get up and go” factor. Even though I have a disability, I still want to be active to keep on with my interests. Thank you for your help

Dr Bond's reply:
There is no need why any of these should happen providing you come off HRT very slowly and ensuring that you take the appropriate vitamin and mineral supplements. I would suggest taking Estroven, which with its isoflavones can help balance your oestrogen levels. Also, Silica-OK may help maintain healthy hair and nails and Bodymax, a multivitamin and mineral with ginseng, can help maintain your get up and go. Don’t forget a positive attitude is also important.

February 2004

Dear Dr. Bond,
I had a total hysterectomy when i was 35 yrs old, i am now 44, for endometriosis. Since then i have tried all sorts of HRT, at present i am on Tibolone. i still feel like i am a 44 yr old in an 84 yr olds body, tired, aching, moody, depressed and continue to put on weight although I exercise far more than i ever used to. i wondered if i may be suffering from a lack of progesterone and if it would be worth me getting some cream ? Please can you help? Regards, Tina.

Dr Bond's reply:
You do not say whether you had or not your ovaries removed but I suspect that you did. A total hysterectomy is actually only the total removal of the womb although the term is often used to include, incorrectly, removal of ovaries as well. [The correct term is hysterectomy combined with ovarectomy]. If your ovaries were removed you are probably suffering from a lack of both oestrogen and progesterone. Tibolone does not contain any oestrogen or progesterone. I would suggest that you ask to be prescribed oestrogen, in the form of Hormonin and half a tablet a day would probably be enough. Have it balanced with progesterone, either as a 3% cream or in the form of tablets (Uterogestan). The Hormonin would be taken daily and the progesterone for two or three weeks out of every four. You might like to try a good food supplement such a Confiance too, which contains five useful minerals and six vitamins to help the body adjust naturally to changes at this time.

Dear Dr. Bond,
I am a 50 year old women. Having discovered I was suffering with severe endemetrosis for several years I had a total hysterectomy in July 2003. For two months post-op I was great. No continual bleeding, no anemia - wonderful.. Then "zap" I felt I was being gradually brought to a closure! These changes in my body, like an imbalance, felt it wasn't me any more. I started the "talked about" hot flushes, every 15 mins this surge of heat through my body (day & night), vaginal dryness, headaches and feelings of low self esteem. Added to which, I feel I am driving my partner further and further away because of no libido! Just this feeling of emptiness. What are your thoughts generally? My consultant has suggested to go on Oestrogen patches, do I give it a go? Would welcome any information. Thank you. Wendy

Dr Bond's reply:
A total hysterectomy usually means that they also remove your ovaries. This is why you have the onset of menopausal problems. While using an oestrogen patch would of course deal with the hot flushes and other menopausal problems, it could start up your endometriosis again if you had any lesions in the abdominal cavity and you would be back experiencing pain etc. I would suggest that you first of all try some Estroven, which contains isoflavones and is known to help with the problems you describe but will not reactivate your endometriosis.

Dear Dr. Bond,
I am 52 and have been taking Trisequens (HRT) for 10 years. In view of current medical advice, I have decided that I would like to come off it. I have consulted my doctor who has suggested I just stop taking the tablets. However, the advice I have read is to reduce the dosage gradually but, as there are 3 different tablets to be taken during the month, my doctor is unable to advise me how to do this . Can you help me, please? Linda Lindsay

Dr Bond's reply:
The way to wean off is to work your way through the pack taking tablets in the same order as before but take them on alternate days, thus a months supply will last for two months. Then take them every third day spreading the pack over nearly three months. This should work especially if you take a supplement called Estroven at the same time.

Dear Dr. Bond,
I am 52 andI have been on HRT for 4 years, Evoril Sequi patches, and for about the last year the continuous type Evoril Conti. I am not happy to continue with it as throughout I have had bleading and the doctor I see said I had to stop it because of the unexplained bleeding. I was advised to stop immediately which I did but now I have terrible night and day sweats continuallty. I have been off it now since Dec 12 and not had an uninterrupted night's sleep since. I have been taking red clover for about a month but it has not helped. I have just gone on to Black Cohosh (1 week in) and so far no improvement. I also take Vit C, Calcium/magnesium,Star Flower Oil and cod liver oil. I would be grateful for any advice as I am suffering quite a bit. I know you say HRT should be stopped gradually but it is too late now as I don't want to go back on even if only on a smaller dose (as recommended). I am surprised the doctors don't advise that it should be stopped gradually as I would have gone that route. Other than this I am in good health and try to exercise regularly. I look forward to your reply and thank you in advance. Jo Churchill

Dr Bond's reply:
Dear Jo, as you say the problem is that you stopped your HRT too quickly, I would suggest that you ask your doctor to put you back on a very low dosage of HRT and then wean off using Estroven as you do so. See our fact sheet on comning off HRT for giudance as to which hormones to ask your doctor to prescribe.

Dear Dr. Bond,
I am 51 years old and had a hysterectomy in 1996 due to constant bleeding. The surgeon removed my left ovary and as the right one was okay, he said I wouldn't be needing HRT for a few years. I began to take HRT prescribed by my Doctor in 1998 and noticed that I put weight on rather quickly and eventually began to 'forget' things. I decided to come off the HRT in 2000 which the Well Woman Nurse agreed and started to take alternative tablets bought from my local health shop. It was suggested I tried Black Cohosh, Sage and Red Clover but only take one type at a time for 3 months. I didn't feel any different whilst taking Black Cohosh and the hot flushes I was having stayed the same. I then tried Sage with a multivitamin for 6 months and still experienced hot flushes to the extent that I had to get up in the night and couldn't concentrate in the day. I became tired easily and irritable due to the sleep disturbances. I then tried Red Clover, still took the multivitamins, started taking Evening Primrose with Cod Liver Oil tablets and went on a High Fibre diet as I started to have digestive problems. I continued the course of the tablets bought and have upgraded my intake of Soya and probiotic yoghurts alongside wholegrain products and organic fruit & vegetables. I do not smoke, drink a 14% aperitif with water once or twice a week and keep myself occupied with walking, reading, meeting people. I am now on Soya Isoflavones and multivitamins for the over 50's as I still had the flushes. I have the hot flushes day and night, sometimes more than others, have lost weight due to the change in diet, have better digestion and generally feel okay. I have had some stress this last year due to family but have got that under control. I wonder if you could suggest something I could take to reduce the hot flushes as I feel they are making me depressed as well as tired and am I doing right by being on a better diet plan and taking in Soya on a regular basis? Thank you for your help, I appreciate it. Regards, Margaret - Grimsby, England.

Dr Bond's reply:
Dear Margaret, you do not say how you came off your HRT. I suspect that you just stopped it rather than weaned off. I would suggest that you consider going back on to your HRT and as soon as your problems have resolved you should start reducing your HRT dose very slowly. At the same time as you reduce your HRT, you should start taking Estroven. For help with this, consult our fact sheet on how to come off HRT. I hope this time will work for you.

January 2004

Dear Dr. Bond,
In 1997 I had a total hysterectomy and since then have been on Oestrogen patches in varying amounts - currently down to about 25mg. Due to bereavement and long term sick leave due to a back problem, stress levels in my life have been considerable for the last 18months and so I imagine my cortisol levels are quite low. I questioned my GP about coming off HRT in view of recent research findings and he advised me to go "cold turkey" and refused to prescribe any more patches. I have to say I feel he is completely out of touch with the implications of doing it this way, and as I still have a few patches left I intend to reduce them even further by cutting them in half before stopping completely. In view of my situation as described, do you advise the use of a progesterone cream to help deal with the return of menopausal symptoms - and if so, how long would you advise me to use it for?
Many thanks for your advice, Lyn Read.

Dr Bond's reply:
Unfortunately , you do not tell me how old you are or why you had to have your historectomy. Also I do not have other medical details relating to you. If you are younger than what it is considered to be the normal menopausal age, then you should probably continue on oestrogen but on as low dose as possible to avoid flushes and sweats. If you are past the age of, or near the age of your natural menopause, then I would suggest that you wean off the oestrogen. Details of how to do this are in our fact sheet on the subject. If you decide that it is appropriate for you to stay on oestrogen for a while, then you should consider seriously the importance of taking natural progesterone as well. This is very important to balance the unwanted side effects of oestrogen such as heart problems and breast cancer. Again there is a fact sheet on the subject of natural hormones and one on progesterone you can read to find out more about these products.

Dear Dr Bond
I went on HRT about 10 years ago as I approached the menopause. I did not have any problems but I was terrified of growing old and looking old and my doctor assured me that taking HRT was a good idea. I am still worried about looking old but am also worried about the recent reports that HRT increases the risk of breast cancer. What should I do?

Dr Bond's reply:
It was wrong of your doctor to give you the impression that HRT was an elixir of youth. A youthful appearance is more likely to relate to a woman’s general health and nutrition than to her hormone balance and to the life style that she has led. There is indeed a lot of media hype regarding HRT keeping a woman youthful but most of this is produced by the drug companies and is part of their marketing strategy. There is no clinical evidence that taking HRT keeps a woman looking younger. While I understand your concerns, you should seriously consider coming off HRT. Do not do this suddenly but wean off (advice re this is on our fact sheet). At the same time, you should look at your life style and make sure that you are doing all you can to maintain good health and nutrition. This would include a good diet as well as taking a good general vitamin and mineral supplement and supporting your hormone balance with a product such as Estroven which contains isoflavones as well as providing a combination of vitamins and minerals.

Dear Dr Bond
I have a family history of osteoporosis and my doctor has suggested that I take HRT to prevent having it myself. I am 49 and seem to be starting the menopause.

Dr Bond's reply:
Certainly a family history of osteoporosis puts you at increased risk of having it yourself. However, it is not certain that you will develop it. First of all you should ask your doctor to arrange an osteoporosis screening to see what level of bone mineral density (BMD) you have. If your BMD is normal or above, then your risk of developing osteoporosis is low. The sensible thing to do would be to ensure that you have a good diet providing bone building vitamins and minerals and take reasonable weight bearing exercise. You can then repeat your osteoporosis screening after your menopause. If your BMD is low, then your doctor needs to look more closely into the problem. I normally suggest that my patients have a urine test known as a Dpd test. This measures the amount of a chemical in the urine that in its term indicates bone metabolism. If the Dpd is high, it suggests that you are currently losing bone but if it is low it shows you are building up bone. In between, it shows steady metabolism. The importance of this test is that it tells you whether the problem is one existing now or whether it relates to problems in the past. If you BMD is low and your Dpd is low or normal then all you need to do is build up new bone. If your BMD is low and the Dpd is high then you must stop the breakdown of bone. Bone can be built up using a combination of a bone building nutrients such as calcium, magnesium, boron, silica vitamins C and D. A supplement product such as Calci-Chew containing just calcium and vitamin D is not sufficient. Exercise and natural progesterone can also be very helpful. Taking oestrogen can slow bone break down as can a bi-phosonate but these only work while you take them. A supplement containing Omega 3 fatty acids, like in fish oils, can also slow bone break down.

Dear Dr Bond
I am in my early 40’s how can I ensure that I do not have problems when I reach my menopause?

Dr Bond's reply:
You are very sensible to be thinking about your menopause before you get there. First of all the menopause is not a disease nor is it a hormone deficient condition, it is natural stage in woman’s life. You may have no problems but unfortunately many women do which is why you ask this question. In my experience working with women over more than 20 years, it is so clear to me that women who look after their general nutritional and hormonal health throughout their lives have far fewer menopausal problems than others. It is never too late to start and I suggest that you read our various fact sheets so that you know what can happen and what you can do about it other than taking HRT. Also look at your life style and try to reduce the effect that any stress has on you. Look at your diet, in particular keep your alcohol and coffee intakes low. Ensure that you eat a good balanced whole food diet and possibly take supplements to help your hormone balance such as Confiance.

December 2003

Dear Dr Bond
I have been taking medroxyprogesterone orally for 18 months - this was originally given to bring under control a prolonged heavy bleeding which has been going on for 3 months. I take 50 mg daily. The reason for the heavy bleed I now know is that I have a fibroid. My current medication largely keeps the bleeding under control but periodically, especially if I over-exert myself I can bleed for 3 weeks and lose large clots. My GP has suggested that I think about the Mirena coil. I have talked with the doctor who would fit it and basically he frightened the life out of me. He told me I would need a day off work, that I am likely to feel sick and in pain afterwards and may not be able to drive myself home. Add to that the mixed reports I have read on the Internet and my own mixed feelings. I feel torn. Would it really be better to have locally delivered progesterone? Will it have an effect given that my original bleeding was due to a fibroid and not thickening of the uterine lining? Are there any major drawbacks to continuing my current medication until after menopause when I am told that fibroids are likely to shrink anyway? Can you offer any recommendations?
Thanks. Jeanette

Dr Bond's reply:
I would consider a Mirena